Clinical management decisions are related to the impact of psoriasis on patient-rated quality of life

BACKGROUND: Clinical decisions over psoriasis are based on many factors. Patients' quality of life (QOL) is not directly related to disease severity alone as judged by physical signs, so decisions should not be based on physical assessments alone. This is increasingly important as new potent biological therapies become available. OBJECTIVES: This study aimed to determine whether clinicians' routine decisions in psoriasis correlate with patient-rated QOL. PATIENTS AND METHODS: Over 35 weeks all 687 outpatient psoriasis consultations by 13 clinicians were included. Each patient received a Dermatology Life Quality Index (DLQI) questionnaire following their consultation. Case notes were analysed to assign management decisions taken by clinicians to one of 11 categories. Patient-rated DLQI was correlated with the type of management decision. RESULTS: Three hundred and eighty-three completed DLQI questionnaires were analysed. Within the 'no change to main type of therapy' group the mean DLQI for patients not changing the potency, dose or frequency of main treatment was 8.9. For patients in whom the potency, dose or frequency of main treatment was increased, the mean DLQI was 11.9. For patients in whom the potency, dose or frequency of main treatment was decreased, the mean DLQI was 6.2. Major management decisions were associated with a high mean DLQI such as change of topical therapy (11.2), topical to systemic therapy (14.8), change of systemic therapy (16.7), starting photo(chemo)therapy (13) and requiring hospital admission (14.4). By contrast, patients discharged reported low DLQI values (mean 4.0). The cohort of patients in whom a decision was taken to start day treatment had a surprisingly low mean DLQI of 8.6. Significant differences in mean DLQI were seen in the cohorts classified by type of management decision. For example, when the mean DLQI values in each cohort were compared (Mann-Whitney U-test), significant differences were seen between the cohorts in whom treatment was increased in potency, dose or frequency, compared with the cohorts whose treatment was unchanged (P < 0.05) or decreased (P < 0.01) or who were discharged from clinic (P < 0.01). CONCLUSIONS: In psoriasis there is a relationship between the type of management decision and the patient-rated QOL. However, there is a very wide score scatter for each management decision, challenging the appropriateness of some clinical decisions.     

The impact of psoriasis on quality of life

Psoriasis is a chronic inflammatory skin disease in which the signs vary from one patient to another and over time. Traditionally, physicians have used various parameters to assess the severity of the disease: percentage of body surface area covered, erythema, plaque thickness, degree of scaling and systemic symptoms such as arthritis. However, these clinical assessments alone do not accurately reflect the overall effect of the disease on patients' daily activities. Apart from the clinical severity of affected areas, psoriasis can also have a profound psychosocial impact on the patient's quality of life. This concept is multidimensional, encompassing the physical, social and psychological wellbeing of the person and is based on the patient's view of their condition.     

The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients

OBJECTIVE: The aim of this study was to determine the effect of stressful life events on the onset and exacerbation of psoriasis, depression, anxiety, life satisfaction and affective expression levels in psoriasis patients and psychological risk factors related to psoriasis. METHOD: Fifty psoriasis patients were examined dermatologically and psychiatrically and then administered the Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Scale (STAI I-II), Life Satisfaction Scale (LSS), Courtauld Emotional Control Scale (CECS) and Body Image Satisfaction Scale (BIS). Symptom severity was measured by the Psoriasis Area Severity Index (PASI). RESULTS: Thirty-four patients declared that they had had a psychologically stressful life event in the last 3 months prior to the beginning of the illness. The mean PASI score was 1.75+/-1.65; BDI score 13.58+/-6.11; STAI-I score 39.54+/-9.18, STAI-II score 46.58+/-8.05; LSS score 9.18+/-4.39; CECS score 51.64+/-9.75; BIS score 93.74+/-16.67. CONCLUSION: Psoriasis patients reported significantly higher degrees of depression and more body cathexis problems than controls. In addition, the risk for developing psoriasis increased significantly in patients with moderate and severe depression. We also found a relationship between symptom severity and low affective expression and high BDI scores in this study. These findings suggest that the relationship between psoriasis and psychological problems can be reciprocal and requires further investigation.     

银屑病患者瘙痒特征及其对生活质量的影响

目的:确定银屑病患者的瘙痒特征并评价其生活质量。方法:采用问卷调查的方法,评价银屑病患者的瘙痒特征和生活质量。结果:131例银屑病患者中有89.31%伴有不同程度的瘙痒,其中87.18%的患者因瘙痒影响心情,62.39%因瘙痒影响睡眠;相关分析显示,瘙痒强度、频率、持续时间与银屑病严重程度和皮损红斑、浸润、脱屑呈正相关(P0.05)。结论:大多数银屑病患者有不同程度的瘙痒,且对患者的生活质量产生的负面影响。     

Perceived relationships between severity of psoriasis symptoms,gender, stigmatization and quality of life

Background Psoriasis is a skin disease with negative physical, psychological and social repercussions for those affected, but we still lack knowledge of how somatic and non‐somatic factors directly and indirectly combine to affect patients’ quality of life (QoL). Objectives This study seeks a better understanding of the relations between symptom severity, discomfort, stigmatization, gender and QoL among psoriasis patients. Methods The sample comprised 381 psoriasis patients in inpatient care. Symptom severity and discomfort were measured subjectively with single items. Stigmatization was measured with the Questionnaire on Experience with Skin Complaints. QoL was measured using the Dermatology Life Quality Index (DLQI) and the Short Form‐8 Health Survey (SF‐8). Results Symptom severity was associated with higher discomfort, stigmatization and lower skin‐related QoL. Symptom severity correlated weakly with more general aspects of QoL as measured by the SF‐8. Men and women reported different experiences with discomfort, stigmatization and mental aspects of QoL (SF‐8 mental component summary score). Some stigmatization parameters function as mediating variables between symptom severity and QoL. Conclusions Our findings suggest that the effect of stigmatization on skin‐related QoL is driven by symptom severity and stigmatization combined, whereas its effect on mental health is driven mostly by stigmatization alone. Further, although women and men experience the social impact of psoriasis differently, the effect of stigmatization on QoL is similar for both genders.     

Stress and quality of life in psoriasis: an update

Psoriasis is a chronic, relapsing, cutaneous condition with 1-2% prevalence in the general population. There are many factors involved in the induction and/or exacerbation of psoriasis of which stress is a well-known trigger factor in the appearance or exacerbation of psoriasis. Stress reaction in patients with psoriasis is probably mediated by the hypothalamic-pituitary-adrenal relationship with immunologic effects. Stress response involves increased levels of neuroendocrine hormones and autonomic neurotransmitters. Psychological stress or an abnormal response to stressors has been found to modify the evolution of skin disorders such as psoriasis. It can also have substantial psychological, and psychosocial impact on a patient's quality of life. Treatment regimens include stress-reduction strategies, such as biofeedback, meditation, yoga, and self-help approaches. This review focuses the relationship between psoriasis and stress, especially relating to psychosocial, psychological, and emotional stress aspects.     

Impact of psoriasis on quality of life in Kuwait

BACKGROUND: Psoriasis can seriously affect the quality of life (QOL) of patients and has a strong impact on social relations, psychological status and daily activities. OBJECTIVE: The aim of this study was to describe the impact of different grades of severity in psoriasis on QOL in patients in Kuwait. PATIENTS/METHODS: We used the Dermatology Quality Of Life scale (DQOLS) developed by Morgan and then validated for use in Kuwait to study a sample of 330 out-patients with psoriasis. RESULTS: Overall, physical activities were affected in greater than 50% of cases. This figure increased significantly with increased severity of psoriasis. Also, social relationships were disrupted in more than half of the patients but with no significant difference between different grades of severity. All psychological feeling items were affected by psoriasis to variable degrees. However, significant differences related to the severity of psoriasis were detected: feeling embarrassed, feeling short tempered, feeling depressed, and feeling a lack of hope. One third of cases declared their sexual activities were affected by psoriasis. CONCLUSION: Data provided should improve the physicians' awareness of the importance of patients' QOL and enhance psychological evaluation of the psoriatic patient which will promote his/her positive outcome and compliance with treatment.     

Age, gender, quality of life and psychological distress in patients hospitalized with psoriasis

BACKGROUND: Psoriasis has a great impact on the quality of life of patients, and the ageing population is an important public health issue. OBJECTIVES: To investigate whether older patients with psoriasis have a different impairment in quality of life compared with younger patients, considering level of severity, duration of disease, gender and psychological distress. METHODS: The study was performed between February 2000 and February 2002 at the inpatient wards of the Dermatological Institute IDI-IRCCS, Rome, Italy, in the framework of a large project on clinical, epidemiological, emotional and quality of life aspects of psoriasis (IMPROVE study). This is a hospital-based cross-sectional study, with measures of quality of life (Skindex-29, Dermatology Life Quality Index and Psoriasis Disability Index) and of psychological distress, generic (12-item General Health Questionnaire) and psoriasis-related (Psoriasis Life Stress Inventory), all self-assessed by patients. We compared the mean scores of each quality of life instrument in patients aged < 65 years and >/= 65 years, in subsets of patients based on clinical and sociodemographic characteristics. RESULTS: We analysed 936 patients hospitalized at IDI-IRCCS with a diagnosis of psoriasis. Quality of life was significantly more impaired in the older group for all the Skindex-29 scales, and psychological distress was higher in older patients. In particular, older women suffering from anxiety or depression had the greatest impairment in quality of life. The results were somewhat different using the other quality of life instruments. CONCLUSIONS: These results should alert dermatologists that similar levels of clinical severity in psoriasis may be associated with different levels of quality of life and psychological distress of patients. Particular attention should be devoted to older patients, and especially to older women.     

Biologics are more potent than other treatment modalities for improvement of quality of life in psoriasis patients

Although mental health is hampered in various skin disorders, few studies regarding anxiety in psoriasis patients are available, and specifically, no evaluation exists between mental health and psoriasis severity or the patients' quality of life. To examine the relation between mental health, psoriasis severity and patient's quality of life, 119 psoriasis vulgaris patients were assessed for anxiety using the General Health Questionnaire (GHQ)‐30. Psoriasis area and severity index (PASI) and Dermatological Life Quality Index (DLQI) scores were also measured. The average total GHQ‐30 score was significantly decreased from 4.41 to 2.11 (52.2% decrease) in biologics‐treated patients. That of patients treated with other systemic agents decreased from 4.36 to 3.32 (23.9% decrease) and that of those treated with topical agents from 4.21 to 3.48 (17.3% decrease). In the biologics‐treated group five of the six categories of GHQ‐30, i.e. general illness, somatic symptoms, sleep disturbance, social dysfunction, and anxiety and dysphoria, were significantly decreased after the treatment. In contrast, in the other systemic treatment and topical treatment groups, three of the six categories, general illness, somatic symptoms, and sleep disturbance were significantly decreased. There was a significant correlation between GHQ‐30 and DLQI, but not with PASI. The psoriasis patients show impaired mental health and among various treatment modalities biologics are superior to other systemic or topical treatments for improving the defective mental state.     

银屑病患者生活质量调查

目的:研究银屑病对患者生活质量的影响及皮肤病生活质量指数(DLQI)作为判断银屑病病情及疗效新指标的可信性。方法:采用DLQI研究银屑病患者治疗前、后的生活质量及其影响因素,并与传统的银屑病皮损面积和严重度指数(PASI)进行比较。结果:女性患者的DLQI评分明显高于男性,未婚者的DLQI评分高于已婚者,面部受累者的DLQI评分高于面部未受累者(P<0.05)。DLQI和PASI评分呈显著正相关(r=0.633,P<0.001)。治疗后随着临床病情的改善,PASI和DLQI评分均显著下降,且DLQI改善率和PASI改善率呈显著正相关(r=0.722,P<0.001)。结论:银屑病对患者生活质量的影响较大,DLQI可作为判断银屑病病情及疗效的新指标。     

Epidemiology and quality of life of patients with psoriasis in Chile

BackgroundClinical characteristics of psoriasis vary between different races and climates. There are few data on Latin American and even fewer on Chilean patients with psoriasis.ObjectivesTo assess that clinical characteristics and quality of life (QoL) of a group of Chilean patients with psoriasis.MethodsA cross-sectional, observational and analytic study was conducted at the Dermatology Department of the Clinical Hospital of the University of Chile between July 2006 and December 2008 applying an epidemiological and QoL-related survey to psoriatic patients.ResultsOne hundred fifty-three patients with psoriasis were included in the study. The mean (SD) age was 42.7 (14.9) years and 60.1% of the patients were male. The most frequent disease subtype was plaque psoriasis (71.9%), followed by “guttatiform” (guttate morphology without confirmed streptococcal infection) psoriasis (17.7%). In 38.6% of patients, less than 10% of body surface area (BSA) was affected. Joint involvement was reported in 28.8% of patients. Those with early onset of disease (before 30 years of age) were more likely to have a positive family history of psoriasis. Hypertension and diabetes were present in 20.3% and 11.1% of patients, respectively. The mean Dermatology Life Quality Index was 14. Greater impact of the disease on QoL was associated with male sex, young age of onset, newly diagnosed disease, facial involvement, and widespread disease.ConclusionChilean patients with psoriasis have clinical characteristics and QoL comparable to patients in other countries. A notable difference, however, was the greater impact of psoriasis on the QoL of Chilean men compared to women.     

Self-reported psoriasis severity and quality of life assessment at Comano spa

The relationship between quality of life (QoL) and skin lesion improvement due to psoriasis treatment has been recently underlined. Our objective was to study the self-reported disease severity reduction and QoL during spa treatments and identify predictors of psoriasis improvement. Patients were assessed before and after spa treatment with a disease-specific QoL questionnaire (Skindex-17) and self-administered psoriasis area and severity index (SAPASI). Their correlations were tested. Factors predicting a reduction in Skindex-17 or in SAPASI score were evaluated through regression analysis. Significant mean overall reductions in SAPASI (27%) and Skindex-17 scores (psychosocial: 6%; symptoms: 2%) were achieved. However, 51% of patients reporting SAPASI improvement also reported a worsened QoL. Pearson's correlation between the SAPASI and Skindex-17 scores was poor (r=0.26 for SAPASI-symptoms and r=0.40 for SAPASI-psychosocial). Logistic regression analysis identified the age of psoriasis onset before 30 years (OR=3.81, 95% CI 1.22-11.95, p=0.02) and a basal Skindex-17 symptoms value greater than 5 (OR=3.37, 95% CI 1.12-10.08, p=0.03) as predictive of both SAPASI and Skindex-17 score reductions. Age-of-onset-based stratification identifies the subset most likely to respond to spa treatment. Combining the Skindex-17 with SAPASI provides a more comprehensive patient-centered assessment. We recommend this assessment for psoriasis patients undergoing spa treatment.     

银屑病病情与生活质量的评测

银屑病是皮肤科的常见病,临床医生常靠直觉确定疾病对患者的影响程度.准确地测量银屑病病情严重程度是制定治疗方案并评价其疗效的重要手段.文中就银屑病严重程度测量方法,包括银屑病体征测量(银屑病面积及严重程度指数、医师整体评估量表和点格系统医师整体评估量表)、与健康相关的生活质量测量(总体健康量表、皮肤科特异性量表、皮肤疾病特异性量表)所采用的符种测评指数和测评量表及严重银屑病判断标准作一综述.     

Stigmatization and quality of life of patients with psoriasis and atopic dermatitis

ZusammenfassungHintergrund und Fragestellung Psoriasis- und Neurodermitispatienten sind häufig von den psychosozialen Konsequenzen ihrer Hauterkrankungen beeinflusst. Um diese Erfahrungen reliabel zu bestimmen, wurden das Stigmatisierungserleben und die Einschränkung der Lebensqualität dieser Patientengruppen untersucht.Patienten/Methodik Die Kurzform des "Fragebogens zum Erleben von Hautbeschwerden" (FEH) mit 23 Items wurde an einer Stichprobe von 463 stationär behandelten Psoriasis- und Neurodermitispatienten validiert. Außerdem wurde der Dermatologische Lebensqualitäts-Index (DLQI) erhoben.Ergebnisse Die 4 FEH-Skalen "Beeinträchtigung des Selbstwertgefühls und Rückzug", "Erfahrene Zurückweisung", "Verheimlichung" und "Gelassenheit" konnten durch eine Faktorenanalyse bestätigt werden. Es fanden sich erwartungsgemäß mittelhohe korrelative Zusammenhänge zwischen den FEH-Skalenwerten und dem DLQI-Gesamtwert bei beiden Patientengruppen. Das Stigmatisierungsgefühl und die Lebensqualität einer Subgruppe der Psoriasis- und Neurodermitispatienten mit vergleichbaren soziodemographischen Charakteristika war nicht signifikant unterschiedlich.Schlussfolgerungen Die Kurzform des FEH ist ein valides Untersuchungsinstrument zur Erfassung sozialer und psychischer Belastungen von Psoriasis- und Neurodermitispatienten. Mit der Bestimmung des Stigmatisierungsgefühls und der Lebensqualität werden unterschiedliche, sich ergänzende Aspekte der krankheitsbezogenen Belastung von Patienten mit chronischen Dermatosen erfasst.

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Measuring quality of life in psoriasis: the CALIPSO questionnaire

In dermatology, several instruments are available to measure health-related quality of life (HRQoL) of patients. They vary in content emphasis and in the extent to which their measurement properties have been investigated and reported. In this study, we summarized five dermatology- and psoriasis-specific HRQoL questionnaires into a new psoriasis-specific questionnaire, the Comprehensive Appraisal of Life Impact of PSOriasis (CALIPSO). The questionnaires were completed by 936 patients with a diagnosis of psoriasis. Rasch's unidimensional measurement model was used to verify the construct validity and the operational characteristics of each instrument separately. The items with the best performance according to the Rasch model were selected. The final 30 items constitute the CALIPSO. Responses are given on a 3-point scale: "never", "sometimes/quite frequently", "often/all the time". The properties of the CALIPSO now need to be verified through the analysis of new data from different populations of people with psoriasis. In future, clinicians may use it without having to decide amongst several competing scales, to evaluate HRQoL in patients with psoriasis.     

Treatment satisfaction,willingness to pay and quality of life in Japanese patients with psoriasis

There is a range of psoriasis treatments available, from topical applications to biologic therapy, with corresponding cost variations. The efficacy of each treatment is usually evaluated by objective measures such as the Psoriasis Area and Severity Index (PASI) or subjective measures such as the Dermatology Life Quality Index (DLQI). However, the social and economic impacts of psoriasis, including cost‐effectiveness, have not been assessed in Japan. The EuroQol 5‐Dimension (EQ‐5D) is a generic instrument used worldwide to calculate quality‐adjusted life years, on which calculations of treatment cost‐effectiveness are based. We conducted a pilot study to determine the cost‐effectiveness of psoriasis treatment in Japan. We administered a questionnaire to 133 patients with psoriasis (105 men and 28 women) who visited four university hospitals in Fukuoka Prefecture. The questionnaire covered medical costs, satisfaction and willingness to pay (WTP), and we investigated the relationships between these items. PASI was evaluated by physicians. More participants indicated satisfaction with treatment in the group paying less than ¥5000/month. WTP, PASI and EQ‐5D showed little correlation. However, the DLQI and EQ‐5D showed a moderate correlation (r = 0.472). WTP seemed more dependent on participants' economic backgrounds. We found that it was difficult to reflect the PASI with the EQ‐5D. However, the DLQI may be used to estimate the cost–benefit relationship in patients with psoriasis. This is the first study to evaluate the EQ‐5D in patients with psoriasis in Japan.